28 research outputs found
Socio-demographic factors, smoking, symptoms, morbidities and pulmonary function and quality of life in individuals with a heavy smoking history
Objective: To determine which socio-demographic, exposure, morbidity and symptom variables are associated with health-related quality of life among former and current heavy smokers.
Methods: Cross sectional data from 2537 participants were studied. All participants were at ≥2% risk of developing lung cancer within 6 years. Linear and logistic regression models utilizing a multivariable fractional polynomial selection process identified variables associated with health-related quality of life, measured by the EQ-5D.
Results: Upstream and downstream associations between smoking cessation and higher health-related quality of life were evident. Significant upstream associations, such as education level and current working status and were explained by the addition of morbidities and symptoms to regression models. Having arthritis, decreased forced expiratory volume in one second, fatigue, poor appetite or dyspnea were most highly and commonly associated with decreased HRQoL.
Discussion: Upstream factors such as educational attainment, employment status and smoking cessation should be targeted to prevent decreased health-related quality of life. Practitioners should focus treatment on downstream factors, especially symptoms, to improve health-related quality of life
Benefits and harms of direct oral anticoagulation and low molecular weight heparin for thromboprophylaxis in patients undergoing non-cardiac surgery : systematic review and network meta-analysis of randomised trials
OBJECTIVE To systematically compare the effect of direct oral anticoagulants and low molecular weight heparin for thromboprophylaxis on the benefits and harms to patients undergoing non-cardiac surgery. DESIGN Systematic review and network meta-analysis of randomised controlled trials. DATA SOURCES Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL), up to August 2021. REVIEW METHODS Randomised controlled trials in adults undergoing non-cardiac surgery were selected, comparing low molecular weight heparin (prophylactic (low) or higher dose) with direct oral anticoagulants or with no active treatment. Main outcomes were symptomatic venous thromboembolism, symptomatic pulmonary embolism, and major bleeding. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for network meta-analyses. Abstracts and full texts were screened independently in duplicate. Data were abstracted on study participants, interventions, and outcomes, and risk of bias was assessed independently in duplicate. Frequentist network meta-analysis with multivariate random effects models provided odds ratios with 95% confidence intervals, and GRADE (grading of recommendations, assessment, development, and evaluation) assessments indicated the certainty of the evidence. RESULTS 68 randomised controlled trials were included (51 orthopaedic, 10 general, four gynaecological, two thoracic, and one urological surgery), involving 45 445 patients. Low dose (odds ratio 0.33, 95% confidence interval 0.16 to 0.67) and high dose (0.19, 0.07 to 0.54) low molecular weight heparin, and direct oral anticoagulants (0.17, 0.07 to 0.41) reduced symptomatic venous thromboembolism compared with no active treatment, with absolute risk differences of 1-100 per 1000 patients, depending on baseline risks (certainty of evidence, moderate to high). None of the active agents reduced symptomatic pulmonary embolism (certainty of evidence, low to moderate). Direct oral anticoagulants and low molecular weight heparin were associated with a 2-3-fold increase in the odds of major bleeding compared with no active treatment (certainty of evidence, moderate to high), with absolute risk differences as high as 50 per 1000 in patients at high risk. Compared with low dose low molecular weight heparin, high dose low molecular weight heparin did not reduce symptomatic venous thromboembolism (0.57, 0.26 to 1.27) but increased major bleeding (1.87, 1.06 to 3.31); direct oral anticoagulants reduced symptomatic venous thromboembolism (0.53, 0.32 to 0.89) and did not increase major bleeding (1.23, 0.89 to 1.69). CONCLUSIONS Direct oral anticoagulants and low molecular weight heparin reduced venous thromboembolism compared with no active treatment but probably increased major bleeding to a similar extent. Direct oral anticoagulants probably prevent symptomatic venous thromboembolism to a greater extent than prophylactic low molecular weight heparin.Peer reviewe
individual participant data meta-analysis of randomised trials study protocol
Introduction Parenteral anticoagulants may improve outcomes in patients with
cancer by reducing risk of venous thromboembolic disease and through a direct
antitumour effect. Study-level systematic reviews indicate a reduction in
venous thromboembolism and provide moderate confidence that a small survival
benefit exists. It remains unclear if any patient subgroups experience
potential benefits. Methods and analysis First, we will perform a
comprehensive systematic search of MEDLINE, EMBASE and The Cochrane Library,
hand search scientific conference abstracts and check clinical trials
registries for randomised control trials of participants with solid cancers
who are administered parenteral anticoagulants. We anticipate identifying at
least 15 trials, exceeding 9000 participants. Second, we will perform an
individual participant data meta-analysis to explore the magnitude of survival
benefit and address whether subgroups of patients are more likely to benefit
from parenteral anticoagulants. All analyses will follow the intention-to-
treat principle. For our primary outcome, mortality, we will use multivariable
hierarchical models with patient-level variables as fixed effects and a
categorical trial variable as a random effect. We will adjust analysis for
important prognostic characteristics. To investigate whether intervention
effects vary by predefined subgroups of patients, we will test interaction
terms in the statistical model. Furthermore, we will develop a risk-prediction
model for venous thromboembolism, with a focus on control patients of
randomised trials. Ethics and dissemination Aside from maintaining participant
anonymity, there are no major ethical concerns. This will be the first
individual participant data meta-analysis addressing heparin use among
patients with cancer and will directly influence recommendations in clinical
practice guidelines. Major cancer guideline development organisations will use
eventual results to inform their guideline recommendations. Several knowledge
users will disseminate results through presentations at clinical rounds as
well as national and international conferences. We will prepare an evidence
brief and facilitate dialogue to engage policymakers and stakeholders in
acting on findings. Trial registration number PROSPERO CRD4201300352
Allergic Rhinitis and its Impact on Asthma (ARIA) Guidelines - 2016 Revision
BACKGROUND: Allergic rhinitis (AR) affects 10% to 40% of the population. It reduces quality of life and school and work performance and is a frequent reason for office visits in general practice. Medical costs are large, but avoidable costs associated with lost work productivity are even larger than those incurred by asthma. New evidence has accumulated since the last revision of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines in 2010, prompting its update.
OBJECTIVE: We sought to provide a targeted update of the ARIA guidelines.
METHODS: The ARIA guideline panel identified new clinical questions and selected questions requiring an update. We performed systematic reviews of health effects and the evidence about patients' values and preferences and resource requirements (up to June 2016). We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence-to-decision frameworks to develop recommendations.
RESULTS: The 2016 revision of the ARIA guidelines provides both updated and new recommendations about the pharmacologic treatment of AR. Specifically, it addresses the relative merits of using oral H1-antihistamines, intranasal H1-antihistamines, intranasal corticosteroids, and leukotriene receptor antagonists either alone or in combination. The ARIA guideline panel provides specific recommendations for the choice of treatment and the rationale for the choice and discusses specific considerations that clinicians and patients might want to review to choose the management most appropriate for an individual patient.
CONCLUSIONS: Appropriate treatment of AR might improve patients' quality of life and school and work productivity. ARIA recommendations support patients, their caregivers, and health care providers in choosing the optimal treatment
Precarious Values and Mundane Innovations: The Diffusion of Enrollment Management in U.S. Higher Education 1970-2005
Drawing primarily from Selznick's institutionalism, we make a general case for renewed attention to the "mundane administrative arrangements" that underlie the organizational capacity for value realization and a particular case for the study of value-subverting management innovations. An empirical study of "enrollment management" in liberal arts colleges reveals this ostensibly innocuous innovation's value-undermining effects and identifies the organizational and environmental factors that have made these venerable organizations more or less susceptible to its adoption
Improving GRADE evidence tables part 2: a systematic survey of explanatory notes shows more guidance is needed
Objectives: The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group has developed GRADE evidence profiles (EP) and summary of findings (SoF) tables to present evidence summaries in systematic reviews, clinical guidelines, and health technology assessments. Explanatory notes are used to explain choices and judgments in these summaries, for example, on rating of the quality of evidence.
Study Design and Setting: A systematic survey of the explanations in SoF tables in 132 randomly selected Cochrane Intervention reviews and in EPs of 10 guidelines. We analyzed the content of 1,291 explanations using a predefined list of criteria.
Results: Most explanations were used to describe or communicate results and to explain downgrading of the quality of evidence, in particular for risk of bias and imprecision. Addressing the source of baseline risk (observational data or control group risk) was often missing. For judgments about downgrading the quality of evidence, the percentage of informative explanations ranged between 41% (imprecision) and 79% (indirectness).
Conclusion: We found that by and large explanations were informative but detected several areas for improvement (e.g., source of baseline risk and judgments on imprecision). Guidance about explanatory footnotes and comments will be provided in the last article in this series. (C) 2016 Elsevier Inc. All rights reservedCochrane Collaboration's Methods Innovation Fund
McMaster GRADE Cente
Improving GRADE evidence tables part 2 : A systematic survey of explanatory notes shows more guidance is needed
Objectives: The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group has developed GRADE evidence profiles (EP) and summary of findings (SoF) tables to present evidence summaries in systematic reviews, clinical guidelines, and health technology assessments. Explanatory notes are used to explain choices and judgments in these summaries, for example, on rating of the quality of evidence. Study Design and Setting: A systematic survey of the explanations in SoF tables in 132 randomly selected Cochrane Intervention reviews and in EPs of 10 guidelines. We analyzed the content of 1,291 explanations using a predefined list of criteria. Results: Most explanations were used to describe or communicate results and to explain downgrading of the quality of evidence, in particular for risk of bias and imprecision. Addressing the source of baseline risk (observational data or control group risk) was often missing. For judgments about downgrading the quality of evidence, the percentage of informative explanations ranged between 41% (imprecision) and 79% (indirectness). Conclusion: We found that by and large explanations were informative but detected several areas for improvement (e.g., source of baseline risk and judgments on imprecision). Guidance about explanatory footnotes and comments will be provided in the last article in this series
Characteristics of RCTs including atrial fibrillation patients.
*<p>The EAFT study has two group of patients taking no VKA.</p